The Impact of Transrectal Prostate Needle Biopsies on Erectile Function

Öz

Object: To evaluate the effects of  transrectal ultrasound guided biopsies of the prostate on patients' sexual function at different time intervals (before and after the procedure).

Material and methods: Eighty prostate cancer free patients were included the study, those were completed the International Prostate Symptom Score and International Index of Erectile Function before, and 1 and 3 mounths after biopsy. We classified erectile function  into five categories according to IIEF-5 scores: severe (5–7), moderate (8–11), mild-moderate (12–16), mild (17-21) and no ED (22–25).

Results: 45% (36/80) of the patients notified rectal bleeding complaints continuing for over three days. Hematospermia and /or hematuria complaints that prolonged over three days were observed at 78.8% (63/80) of patients . The mean IIEF score before biopsy was 24.29 ± 8.40. The mean IIEF score at the first and third months after biopsy was 20.31 ± 9.6 and 22.36 ± 8.88, respectively (p <0.05). In the previously potent patient group, the rate of ED at 1 month after biopsy was 31.57% (18/57). This rate decreased to 5.26% (3/57) at 3 months after biopsy. In the previously potent patient group, post biopsy ED severity was between 17-21 according to IIEF-5 and was entering the mild ED classification.

Conclusion: The biopsy-related sexual dysfunction may be potentially emerged in all patients undergoing prostate biopsy. But based on this study; Post-biopsy sexual dysfunction, especially erectile dysfunction, is often a temporary condition.

Anahtar Kelimeler

• Erectile dysfunction,impotance,international index of erectile function,prostate biopsy

Transrektal Prostat İğne Biyopsisinin Erektil Fonksiyon Üzerine Etkisi

Öz

Amaç: Transrektal ultrasonografi eşliğinde prostat biyosi işleminin, hastaların cinsel fonksiyonu üzerine olan etkilerini, işlem öncesinde ve sonrasında farklı zaman aralıkları ile değerlendirmek.

Hastalar  ve yöntem: Çalışmaya işlem öncesi IPSS ve IIEF doldurtulan ve işlem sonrası bu formlar tekrar 1. ve 3. aylarda doldurtulmuş olan ve biyopsi sonucu prostat kanseri ile uyumlu gelmeyen 80 hasta alındı. IIEF-5’e göre hastaların erektil fonksiyonları 5 kategoriye ayrıldı; 5-7: ağır erektil disfonksiyon (ED), 8-11: orta ED, 12-16: hafif-orta ED, 17-21: hafif ED, 22-25: ED olmayan.

Bulgular: Hastaların  %45’ i (36/80) üç günden fazla süren rektal kanama şikayeti bildirdiler. Üç günden uzun süren hematospermi ve/veya hematüri şikayeti hastaların %78,8’ inde (63/80) gözlemlendi. Biyopsi öncesi IIEF skor ortalaması 24.29±8.40 idi. Biyopsi sonrası 1. ve 3. aylardaki IIEF skor ortalamaları sırası ile 20.31±9,6 ve 22.36±8.88 idi (p<0,05). Biyopsi öncesi ED’ u olmayan  hasta grubunda biyopsi sonrası 1. ayda ED görülme oranı %31.57 (18/57)  idi. Bu oranın 3. ayda %5.26’ ya (3/57) gerilediği tespit edildi. Başlangıçta ED’u olmayan hasta grubunda biyopsi sonrası görülen ED’un şiddeti, IIEF-5’e göre 17-21 arası olup hafif ED sınıflamasına girmekte idi.

Sonuç: Biyopsi ilişkili cinsel disfonksiyon ihtimali, prostat biyopsisi geçiren tüm hastalarda olasıdır. Fakat çalışmamıza dayanarak denebilir ki; biyopsi sonrası seksüel disfonksiyon, özellikle de erektil disfonksiyon çoğu zaman geçici bir durumdur.

Anahtar Kelimeler

• Erektil disfonksiyon,impotans,prostat biyopsisi,uluslararası erektil işlev formu

Kaynakça

1. Referans 1 Loeb S, Vellekoop A, Ahmed HU,Catto J, Emberton M, Nam R et al. Systematic review of complications of prostate biopsy. Eur Urol 2013;64:876–92.
2. Referans 2 Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM. Complications after prostate biopsy: data from SEER-Medicare. J Urol 2011;186:1830–4.
3. Referans 3 Djavan B, Waldert M, Zlotta A, Dobronski P, Seitz C, Remzi M et al. Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective European prostate cancer detection study. J Urol. 2001 Sep;166(3):856-60.
4. Referans 4 Lundström KJ, Drevin L, Carlsson S, Garmo H, Loeb S, Stattin P et al. Nationwide population based study of infections after transrectal ultrasound guided prostate biopsy. J Urol 2014;192:1116–22.
5. Referans 5 Bruyere F, Malavaud S, Bertrand P, Decock A, Cariou G, Doublet JD et al. Prosbiotate: a multicenter, prospective analysis of infectious complications after prostate biopsy. J Urol 2015;193:145–50.
6. Referans 6 Liss MA, Taylor SA, Batura D, Steensels D, Chayakulkeeree M, Soenens C et al. Fluoroquinolone resistant rectal colonization predicts risk of infectious complications after transrectal prostate biopsy. J Urol 2014;192:1673-8.
7. Referans 7 Roberts MJ, Williamson DA, Hadway P, Doi SA, Gardiner RA, Paterson DL. Baseline prevalence of antimicrobial resistance and subsequent infection following prostate biopsy using empirical or altered prophylaxis: A bias-adjusted meta-analysis. Int J Antimicrob Agents 2014;43:301-9.
8. Referans 8 Raaijmakers R, Kirkels WJ, Roobol MJ, Wildhagen MF, Schrder FH. Complication rates and risk factors of 5802 transrectal ultrasound- guided sextant biopsies of the prostate within a population-based screening program. Urology 2002;60:826–30.

9. Referans 9 Berger AP, Gozzi C, Steiner H, Frauscher F, Varkarakis J, Rogatsch H et al. Complication rate of transrectal ultrasound guided prostate biopsy: a comparison among 3 protocols with 6, 10 and 15 cores. J Urol 2004;171:1478–80.
10. Referans 10 Namekawa T, Fukasawa S, Komaru A, Kobayashi M, Imamura Y, Ohzeki T et al. Prospective evaluation of the safety of transrectal ultrasound-guided transperineal prostate biopsy based on adverse events. Int J Clin Oncol 2015;20:1185–91.
11. Referans 11 Manoharan M, Ayyathurai R, Nieder AM, Soloway MS. Hemospermia following transrectal ultrasound-guided prostate biopsy: a prospective study. Prostate Cancer Prostatic Dis 2007;10:283–7.
12. Referans 12 Benet AE, Melman A. The epidemiology of erectile dysfunction. Urol Clin NA 1995;22:699-709.
13. Referans 13 Sairam K, Kulinskaya E, Boustead GB, Hanbury DC, McNicholas TA. Prevalence of undiagnosed prostate cancer in men with erectile dysfunction. BJU Int 2002; 89: 261-3.
14. Referans 14 Feldman HA, Goldstein I, Hatzichristou D, Krane RJ, McKinlay JB. Impotence and its medical and psychological correlates: Results of the Massachusets Male Ageing Study. J Urol 1994;151:54-61.
15. Referans 15 Verrier RL, Dickerson LW. Autonomic nervous system and coronary blood flow changes related to emotional activation and sleep. Circulation 1991;83:1181-1189.
16. Referans 16 Zisman A, Leibovici D, Kleinmann J, Siegel YI, Lindner A. The impact of prostate biopsy on patient well-being: a prospective study of pain, anxiety and erectile dysfunction. J Urol 2001;165(2):445-54.
17. Referans 17 Fujita K, Landis P, McNeil BK, Pavlovich CP. Serial prostate biopsies are associated with an increased risk of erectile dysfunction in men with prostate cancer on active surveillance. J Urol 2009; 182: 2664-9.
18. Referans 18 Hilton JF, Blaschko SD, Whitson JM, Cowan JE, Carroll PR. The impact of serial prostate biopsies on sexual function in men on active surveillance for prostate cancer. J Urol 2012;188:1252-8.
19. Referans 19 van den Bergh RC, Korfage IJ, Roobol MJ, Bangma CH, de Koning HJ, Steyerberg EW, et al. Sexual function with localized prostate cancer: active surveillance vs radical therapy. BJU Int 2012;110:1032-9.
20. Referans 20 Chrisofos M, Papatsoris AG, Dellis A, Varkarakis IM, Skolarikos A, Deliveliotis C. Can prostate biopsies affect erectile function? Andrologia 2006;38:79–83.
21. Referans 21 Murray KS, Bailey J, Zuk K, Lopez-Corona E, Thrasher JB. A prospective study of erectile function after transrectal ultrasonography-guided prostate biopsy. BJU Int. 2015 Aug;116(2):190-5.